View Information Collection (IC)

View Information Collection (IC)

WIC Participant
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-App.E.1_Eng.Screening_Enrollment.Participant.Interview. App E 1_Eng Screening_Enrollment Participant Interview (revised).docx Yes Yes Fillable Fileable
Other-App.E.2_Span.Screening_Enrollment.Participant.Interview App E 2_Span Screening Enrollment Participant Interview (revised).docx Yes Yes Fillable Fileable
Other-App.F.1_Eng.Prenatal Enrollment Package.Letter App.F.1_Eng.Prenatal Enrollment Package.Letter.docx No   Paper Only
Other-App.F.2_Span.Prenatal Enrollment Package.Letter App.F.2_Span Prenatal Enrollment Package.Letter.docx No   Paper Only
Other-App.G 1_Eng Postnatal Enrollment Package Letter App.G 1_Eng Postnatal Enrollment Package Letter.V2.docx No   Paper Only
Other-App.G 2_Span Postnatal Enrollment Package Letter App.G 2_Span Postnatal Enrollment Package Letter.V2.docx No   Paper Only
Other-App.I.1_Eng.Prental Participant Interview App.I.1_Eng.Prental Participant Interview.docx Yes Yes Fillable Fileable
Other-App.I.2_Span.Prenatal Participant Interview App.I.2_Span.Prenatal Participant Interview.docx Yes Yes Fillable Fileable
Other-App.J.1_Eng.1 Month Participant Interview App.J.1_Eng.1 Month Participant Interview (revised).docx Yes Yes Fillable Fileable
Other-App.J.2_Span.1 Month Participant Interview App.J.2_Span.1 Month Participant Interview (revised).docx Yes Yes Fillable Fileable
Other-App.K.1_Eng.3 Month Participant Interview App.K.1_Eng.3 Month Participant Interview.docx Yes Yes Fillable Fileable
Other-App.K.2_Span.3 Month Participant Interview App.K.2_Span.3 Month Participant Interview.docx Yes Yes Fillable Fileable
Other-App.L.1_Eng.5 Month Participant Interview App.L.1_Eng.5 Month Participant Interview.docx Yes Yes Fillable Fileable
Other-App.L.2_Span.5 Month Participant Interview App.L.2_Span.5 Month Participant Interview.docx Yes Yes Fillable Fileable
Other-App.M.1_Eng.7 Month Participant Interview App.M.1_Eng.7 Month Participant Interview.docx Yes Yes Fillable Fileable
Other-App.M.2_Span.7 Month Participant Interview App.M.2_Span.7 Month Participant Interview.docx Yes Yes Fillable Fileable
Other-App.N.1_Eng.9 Month Participant Interview App.N.1_Eng.9 Month Participant Interview.docx Yes Yes Fillable Fileable
Other-App.N.2_Span.9 Month Participant Interview App.N.2_Span.9 Month Participant Interview.docx Yes Yes Fillable Fileable
Other-App.O.1_Eng.11 Month Participant Interview App.O.1_Eng.11 Month Participant Interview.docx Yes Yes Fillable Fileable
Other-App.O.2_Span.11 Month Participant Interview App.O.2_Span.11 Month Participant Interview.docx Yes Yes Fillable Fileable
Other-App.P.1_Eng.13 Month Participant Interview App.P.1_Eng.13 Month Participant Interview.docx Yes Yes Fillable Fileable
Other-App.P.2_Span.13 Month Participant Interview App.P.2_Span.13 Month Participant Interview.docx Yes Yes Fillable Fileable
Other-App.Q.1_Eng.15 Month Participant Interview App.Q.1_Eng.15 Month Participant Interview.docx Yes Yes Fillable Fileable
Other-App.Q.2_Span.15 Month Participant Interview App.Q.2_Span.15 Month Participant Interview.docx Yes Yes Fillable Fileable
Other-App.R.1_Eng.18 Month Participant Interview App.R.1_Eng.18 Month Participant Interview.docx Yes Yes Fillable Fileable
Other-App.R.2_Span.18 Month Participant Interview App.R.2_Span.18 Month Participant Interview.docx Yes Yes Fillable Fileable
Other-App.S.1_Eng.24 Month Participant Interview App.S.1_Eng.24 Month Participant Interview.docx Yes Yes Fillable Fileable
Other-App.S.2_Span.24 Month Participant Interview App.S.2_Span.24 Month Participant Interview.docx Yes Yes Fillable Fileable
Other-App.T.1_Eng.Baseline module.Participant.Interview App.T.1_Eng.Baseline module.Participant.Interview.docx Yes Yes Fillable Fileable
Other-App.T.2_Span.Baseline module.Participant.Interview App.T.2_Span.Baseline module.Participant.Interview.docx Yes Yes Fillable Fileable
Other-App.U.1_Eng.New Caregiver module.Participant.Interview App.U.1_Eng.New Caregiver module.Participant.Interview.docx Yes Yes Fillable Fileable
Other-App.U.2_Span.New Caregiver module.Participant.Interview App.U.2_Span.New Caregiver module.Participant.Interview.docx Yes Yes Fillable Fileable
Other-App.V.1 Eng Automated Multiple Pass Method 24HR.Module.Screenshots (revised) App.V.1 Eng Automated Multiple Pass Method 24HR.Module.Screenshots (revised).pdf Yes Yes Fillable Fileable
Other-App.DD.1_Eng.HomeHealthcareAgency.LengthWeight.Form App.DD.1_Eng.HomeHealthcareAgency.LengthWeight.Form.docx No   Paper Only
Other-App.DD.2_Span.HomeHealthcareAgency.LengthWeight.Form App.DD.2_Span.HomeHealthcareAgency.LengthWeight.Form.V2.docx No   Paper Only
Other-App.EE.1_Eng.Home Health Visit Script.LengthWeight App.EE.1_Eng.Home Health Visit Script.LengthWeight.docx No   Paper Only
Other-App.EE.2_Span.Home Health Visit Script.LengthWeight App.EE.2_Span.Home Health Visit Script.LengthWeight.docx No   Paper Only
Other-App V 2_Span Automated Multiple Pass Method 24HR Module Screenshots App V 2_Span Automated Multiple Pass Method 24HR Module Screenshots.pdf Yes Yes Fillable Fileable

Income Security Food and Nutrition Assistance

Privacy Act of 1974  5 FR 552

4,468 0
   
Individuals or Households
 
   99 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 18,667 0 18,667 0 0 0
Annual IC Time Burden (Hours) 4,426 0 4,426 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
App.A.1_Eng.WIC Poster App.A.1_Eng.WIC Poster-v2.pdf 12/18/2012
App.A.2_Span.WIC Poster App.A.2_Span.WIC Poster-V2.pdf 12/18/2012
App.B.1_Eng.Participant Flyer App.B.1_Eng.Participant Flyer.docx 12/18/2012
App.B.2_Span.Participant Flyer App.B.2_Span.Participant Flyer.docx 12/18/2012
App.H 1_Eng Post Birth HIPAA Letter App.H 1_Eng Post Birth HIPAA Letter.V2.docx 12/18/2012
App.H 2_Span Post Birth HIPAA Letter App.H 2_Span Post Birth HIPAA Letter.V2.docx 12/18/2012
App.Y.1_Eng_Core Participant Informed Consent App.Y.1_Eng_Core Participant Informed Consent Amended Privacy (23May13).docx 05/23/2013
App.Y.2_Span_Core Participant Informed Consent App.Y.2_Span_Core Participant Informed Consent Amended Privacy (23May13).docx 05/23/2013
App.Z.1_Eng_Supplemental Participant Consent App.Z.1_Eng_Supplemental Participant Consent Amended Privacy (23May13)docx.docx 05/23/2013
App.Z.2_Span_Supplemental Participant Consent App.Z.2_Span_Supplemental Participant Consent Amended Privacy(23May13).docx 05/23/2013
App.NN.1_Eng.Participant Reminder Scripts App.NN.1_Eng.Participant Reminder Scripts.docx 12/18/2012
App.NN.2_Span.Participant Reminder Scripts App.NN.2_Span.Participant Reminder Scripts.docx 12/18/2012
App.OO.1_Eng.Thankyou Letter App.OO.1_Eng.Thankyou Letter.docx 12/18/2012
App.OO.2_Span.Thankyou Letter App.OO.2_Span.Thankyou Letter.docx 12/18/2012
App.TT.Confidentiality & Nondisclosure Agreement App.TT.Confidentiality & Nondisclosure Agreement.docx 12/18/2012
App.W.1_Eng 13 Month FoodModelBooklet.Letter App.W.1_Eng 13 Month FoodModelBooklet.Letter.docx 12/19/2012
App.W.2_Span 13 Month FoodModelBooklet.Letter App.W.2_Span 13 Month FoodModelBooklet.Letter.docx 12/19/2012
App.X.1_Eng Note sheet for AMPM.docx App.X.1_Eng Note sheet for AMPM.docx 12/19/2012
App.X.2_Span Note sheet for AMPM App.X.2_Span Note sheet for AMPM.docx 12/19/2012
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.